Second victim phenomenon: impact on healthcare professionals, organizational responsibility and support strategies
DOI:
https://doi.org/10.15649/cuidarte.5072Keywords:
Health Personnel, Medical Errors, Safety Management, Psychological Trauma, Patient SafetyAbstract
Highlights
- The Second Victim phenomenon affects healthcare teams globally, yet it often remains invisible to executives and society.
- The occurrence of errors triggers psychological, cognitive, and/or physical reactions in the professionals involved; recovery depends on individual, organizational, and leadership factors.
- Healthcare institutions and leaders should adopt policies and practices that promote a safety culture, encouraging non-punitive error reporting with appropriate emotional and psychological support for Second Victims.
- Training and preparing healthcare teams to understand the Second Victim phenomenon, and offering support to these professionals are just as important as reporting errors.
Unsafe practices and incidents that result in negative patient outcomes can lead to potential victims. While patients are the primary and most apparent victims, healthcare workers also suffer from their mistakes, in that they experience trauma following the event1 and are deemed the second victims2. The term "second victim" (SV) was first described by Wu (2000), who proposed that physicians who make mistakes also need help. Later, Scott expanded the concept, defining SVs as professionals involved in a health error3. More recently, an international consensus proposed that an SV can be any healthcare worker—whether directly or indirectly involved in an adverse event (AE), unintentional error, or patient-related injury—who is also negatively impacted by the experience of becoming a victim4.
How to cite this article: Martins, Maristela Santini; De Rezende, Helena; Quadrado, Ellen Regina Sevilla; De Paula, Andresa Gomes; Carmo, Hércules de Oliveira; Nascimento, Vagner Ferreira do. Second victim phenomenon: impact on healthcare professionals, organizational responsibility and support strategies. Revista Cuidarte. 2025;16(2):e5072. https://doi.org/10.15649/cuidarte.5072
References
Seys D, Wu AW, Gerven EV, Vleugels A, Euwema M, Panella M et al. Health care professionals as second victims after adverse events: a systematic review. Eval Health Prof. 2013;36(2):135-62. https://doi.org/10.1177/0163278712458918
Wu AW. Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ. 2000;320:726. https://doi.org/10.1136/bmj.320.7237.726
Scott SD, Hirschinger LE, Cox KR, McCoig M, Brandt J, Hall LW. The natural history of recovery for the healthcare provider "second victim" after adverse patient events. Qual Saf Health Care. 2009;18(5):325-30. https://doi.org/10.1136/qshc.2009.032870
Vanhaecht K, Seys D, Russotto S, Strametz R, Mira J, Sigurgeirsdóttir S, et al. An Evidence and Consensus-Based Definition of Second Victim: A Strategic Topic in Healthcare Quality, Patient Safety, Person-Centeredness and Human Resource Management. Int J Environ Res Public Health. 2022;19(24):16869. https://doi.org/10.3390/ijerph192416869
Busch IM, Moretti F, Purgato M, Barbui C, Wu AW, Rimondini M. Psychological and Psychosomatic Symptoms of Second Victims of Adverse Events: A Systematic Review and Meta-Analysis. J Patient Saf. 2020;16(2):e61-e74. Erratum. J Patient Saf. 2020;16(3):e211. https://doi.org/10.1097/PTS.0000000000000779
Treiber LA, Jones JH. Devastatingly Human: An Analysis of Registered Nurses’ Medication Error Accounts. Qual Health Res. 2010;20(10):1327–1342. https://doi.org/10.1177/1049732310372228
Cohen R, Sela Y, Hochwald IH, Nissanholz-Gannot R. Nurses' Silence: Understanding the Impacts of Second Victim Phenomenon among Israeli Nurses. Healthcare (Basel). 2023;11(13):1961. https://doi.org/10.3390/healthcare11131961
Harrison R, Lawton R, Stewart K. Doctors' experiences of adverse events in secondary care: the professional and personal impact. Clin Med. 2014;14(6):585-90. https://doi.org/10.7861/clinmedicine.14-6-585
Strametz R, Koch P, Vogelgesang A, Burbridge A, Rösner H, Abloescher M, et al. Prevalence of second victims, risk factors and support strategies among young German physicians in internal medicine (SeViD-I survey). J Occup Med Toxicol. 2021;16. https://doi.org/10.1186/s12995-021-00300-8
Krommer E, Ablöscher M, Klemm V, Gatterer C, Rösner H, Strametz R, et al. Second Victim Phenomenon in an Austrian Hospital before the Implementation of the Systematic Collegial Help Program KoHi: A Descriptive Study. Int J Environ Res Public Health. 2023;20(3):1913. https://doi.org/10.3390/ijerph20031913
Neyens L, Stouten E, Vanhaecht K, Mira J, Panella M, Seys D, et al. Open Disclosure Among General Practitioners as Second Victim of a Patient Safety Incident: A Cross-Sectional Study in Flanders (Belgium). J Patient Saf. 2025;21(1):9-14. https://doi.org/10.1097/PTS.0000000000001299
Mira JJ, Carrillo I, Lorenzo S, Ferrús L, Silvestre C, Pérez-Pérez P, et al. The aftermath of adverse events in Spanish primary care and hospital health professionals. BMC Health Serv Res. 2015;15. https://doi.org/10.1186/s12913-015-0790-7
>Institute for Safe Medication Practices Canada - ISMP. Second victim: Sharing the Journey toward Healing. ISMP Canada Safety Bulletin. 2017;17(9):1-6. https://ismpcanada.ca/wp-content/uploads/ISMPCSB2017-10-SecondVictim.pdf
Yoo L, Fei M. The second victim: Supporting healthcare providers involved in medication errors. Hospital News. 2018;31(4):41. https://www.ismp-canada.org/download/hnews/201804-HospitalNews-SecondVictim.pdf
Johnson TN, Tucker AM. Pharmacy prevalence of second victim syndrome in a comprehensive cancer center. Am J Health-Sys Pharm. 2024;82(6):297-305. https://doi.org/10.1093/ajhp/zxae267
Rivera-Chiauzi E, Finney RE, Riggan KA, Weaver AL, Long ME, Torbenson VE, et al. Understanding the second victim experience among multidisciplinary providers in OBGYN. J Patient Saf. 2022;18(2):e463–e469. https://doi.org/10.1097/PTS.0000000000000850
Brunelli MV, Seisdedos MG, Martinez MM. Second Victim Experience: A Dynamic Process Conditioned by the Environment. A Qualitative Research. Int J Public Health. 2024;69:1607399. https://doi.org/10.3389/ijph.2024.1607399
Kappes M, Delgado-Hito P, Contreras VR, Romero-García M. Prevalence of the second victim phenomenon among intensive care unit nurses and the support provided by their organizations. Nurs Crit Care. 2023;28(6):1022-1030. https://doi.org/10.1111/nicc.12967
Silveira SE, Tomaschewski-Barlem JG, Tavares APM, Paloski G do R, Feijó G dos S, Cabral CN. Impacts of patient safety incidents on nursing: a look at the second victim. Rev enferm UERJ. 2023;31(1):e73147. http://dx.doi.org/10.12957/reuerj.2023.73147
Alevi JO, Draganov PB, Gonçalves GCS, Zimmermann GS, Giunta L, Mira JJ, et al. The newly graduated nurse as a second victim. Acta Paul Enferm. 2024;37:eAPE02721. https://doi.org/10.37689/acta-ape/2024AO0027211
Quadros DV de, Magalhães AMM de, Boufleuer E, Tavares JP, Kuchenbecker R de S, et al. Falls Suffered by Hospitalized Adult Patients: Support to the Nursing Team as the Second Victim. Aquichan. 2022;22(4):e2246. https://doi.org/10.5294/aqui.2022.22.4.6
Shapiro J, Galowitz P. Peer Support for clinicians: a programmatic approach. Acad Med. 2016;91(9):1200-4. https://doi.org/10.1097/ACM.0000000000001297
Edrees H, Connors C, Paine L, Norvell M, Taylor H, Wu AW. Implementing the RISE second victim support programme at the Johns Hopkins Hospital: a case study. BMJ Open. 2016;6(9):e011708. https://doi.org/10.1136/bmjopen-2016-011708
Pratt S, Kenney L, Scott SD, Wu AW. How to develop a second victim support program: a toolkit for health care organizations. Jt Comm J Qual Patient Saf. 2012;38(5):235-40. https://doi.org/10.1016/s1553-7250(12)38030-6
Carrillo I, Ferrús L, Silvestre C, Pérez-Pérez P, Torijano ML, Iglesias-Alonso F, et al. Propuestas para el estudio del fenómeno de las segundas víctimas en España en atención primaria y hospitales. Rev Calid Asist. 2016;31(2):3-10. https://doi.org/10.1016/j.cali.2016.04.008
Agency for Healthcare Research and Quality (AHRQ). Care for the Caregiver Program Implementation Guide. Maryland: AHRQ; 2016.
Tobin WN. Medically Induced Trauma Support Services (MITSS). Patiente Safety Quality Healthcare. 2013. https://psnet.ahrq.gov/issue/medically-induced-trauma-support-services-mitss
Scott SD, Hirschinger LE, Cox KR, McCoig M, Hahn-Cover K, Epperly KM, et al. Caring for our own: deploying a systemwide second victim rapid response team. Jt Comm J Qual Patient Saf. 2010;36(5):233-40. https://doi.org/10.1016/s1553-7250(10)36038-7
Ullström S, Sachs MA, Hansson J, Øvretveit J, Brommels M. Suffering in silence: a qualitative study of second victims of adverse events. BMJ Qual Saf. 2014;23(4):325-31. https://doi.org/10.1136/bmjqs-2013-002035
Seys D, Scott S, Wu A, Van Gerven E, Vleugels A, Euwema M, et al. Supporting involved health care professionals (second victims) following an adverse health event: a literature review. Int J Nurs Stud. 2013;50(5):678-87. https://doi.org/10.1016/j.ijnurstu.2012.07.006
Mira JJ, Carrillo I, Lorenzo S, Ferrús L, Silvestre C, Pérez-Pérez P, et al. The aftermath of adverse events in Spanish primary care and hospital health professionals. BMC Health Serv Res. 2015;15. https://doi.org/10.1186/s12913-015-0790-7
Chan ST, Khong PCB, Wang W. Psychological responses, coping, and supporting needs of healthcare professionals as second victims. Int Nurs Rev. 2016;64(2):242-62. https://doi.org/10.1111/inr.12317
Coughlan B, Powell D, Higgins MF. The second victim: a review. Eur J Obstet Gynecol Reprod Biol. 2017;213:11-16. https://doi.org/10.1016/j.ejogrb.2017.04.002
Hall L, Scott SD. The second victim of adverse health care events. Nurs Clin North Am. 2012;47(3):383-93. https://doi.org/10.1016/j.cnur.2012.05.008
White AA, Brock DM, McCotter PI, Hofeldt R, Edrees HH, Wu AW, et al. Risk managers’ descriptions of programs to support second victims after adverse events. J Healthc Risk Manag. 2015;34(4):30-40. https://doi.org/10.1002/jhrm.21169
Pais Iglesias B, Rodríguez Pérez B, Martín Rodríguez MD, Carreras Viñas M. Gestión de segundas víctimas en Galicia. Rev Calid Asist. 2016;31(2):47-49. https://doi.org/10.1016/j.cali.2016.06.001
Scott SD. The second victim phenomenon: a harsh reality of health care professions. Agency for Healthcare Research and Quality. 2011. https://psnet.ahrq.gov/perspective/second-victim-phenomenon-harsh-reality-health-care-professions
Sirriyeh RH. Coping with medical error: the case of the health professional [Thesis Doctoral]. Leeds: University of Leeds; 2011.
Nainar SMH. Adverse events during dental care for children: implications for practitioner health and wellness. Pediatr Dent. 2018;15:40(5):323-326. https://pubmed.ncbi.nlm.nih.gov/30355425/
Joesten L, Cipparrone N, Okuno-Jones S, DuBose ER. Assessing the perceived level of institutional support for the second victim after a patient safety event. J Patient Saf. 2015;11(2):73-78. https://doi.org/10.1097/PTS.0000000000000060
Rivera EY, Lee C, Bernstein PS, Chazotte C, Goffman D. “Second victim” experiences in obstetrics and gynecology. Obstet Gynecol. 2015;125(5):107S. https://doi.org/10.1097/01.AOG.0000463648.49876.ba
Bueno Domínguez MJ, Briansó Florencio M, Colomés Figuera L, Prats Alonso E. Experiencia de unidad de soporte a las segundas víctimas (USVIC). Rev Calid Asist. 2016;31(2):49-52. https://doi.org/10.1016/j.cali.2016.06.002
Hauk L. Support strategies for health care professionals who are second victims. AORN J. 2018;107(6):7-9. https://doi.org/10.1002/aorn.12291
Reason J. Human error: models and management. BMJ. 2000;320(7237):768-70. https://doi.org/10.1136/bmj.320.7237.768
Marx D. Patient Safety And The "Just Culture": A Primer For Health Care Executives. New York: Trustees of Columbia University; 2001.
Järvisalo P, Haatainen K, Von Bonsdorff M, Turunen H, Härkänen M. Interventions to support nurses as second victims of patient safety incidents: A qualitative study of nurse managers' perceptions. J Adv Nurs. 2023;80(6):2552-2565. https://doi.org/10.1111/jan.16013
Quadrado ERS, Tronchin DMR, Maia F de OM. Strategies to support health professionals in the condition of second victim: scoping review. Rev Esc Enferm USP. 2021;55:e03669. https://doi.org/10.1590/S1980-220X2019011803669
Liukka M, Steven A, Vizcaya Moreno MF, Sara-aho AM, Khakurel J, Pearson P, et al. Action after adverse events in healthcare: an integrative literature review. Int J Environ Res Public Health. 2020;17(13):4717. https://doi.org/10.3390/ijerph17134717
Loureiro R, Lima AMN, Ferreira MM, Moreira MTF, Guerra MM, Santos J. Influência dos estilos de liderança no burnout dos enfermeiros: uma scoping review. J Health NPEPS. 2022;7(1):e5987. https://doi.org/10.30681/252610105987
Gasparino RC, Ferreira TDM, Bernardes A. A importância da liderança em enfermagem para o alcance dos objetivos do desenvolvimento sustentável. J Health NPEPS. 2023;8(2):e11956. http://doi.org/10.30681/2526101011956
Published
How to Cite
Downloads
Issue
Section
Categories
License
Copyright (c) 2025 Revista Cuidarte
This work is licensed under a Creative Commons Attribution 4.0 International License.
Journal Cuidarte, scientific publication of open access, is licensed under a Creative Commons Attribution (CC BY-NC), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Any other form of use such as reproduction, transformation, public communication or distribution, for profit, requires the prior authorization of the University of Santander UDES.
The names and e-mail addresses entered in the Journal Cuidarte will be used exclusively for the purposes stated by this magazine and will not be available for any other purpose or other person.
The articles published in the Journal Cuidarte represent the criteria of their authors and do not necessarily constitute the official opinion of the University of Santander UDES.
